Repetitive transcranial magnetic stimulation for the treatment of depression during pregnancy and postpartum period

Objective: Major depressive disorder is common during pregnancy and postpartum. These patients prefer non medicated treatment options. We present the outcomes of the treatment with repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder during pregnancy and postpartum.

Methods: There were forty participants in our study, but twenty-five participants did not complete rTMS treatment sessions. Seven women suffered major depressive disorder during pregnancy and eight women major depressive disorder in the postpartum period. The rTMS intensity was set at 80 % of the motor threshold. A 20-Hz stimulation with a duration of 2s was delivered 20 times with 50s intervals. A session comprised 1,000 pulses. Treatment effect was assessed during treatment sessions 1, 7, and 15.

Results: Four out of fifteen (26%) subjects responded (decrease 50% in Hamilton Depression Rating Scale [HDRS-17] scores). Six out of fifteen (40%) subjects responded (decrease 50% in Hamilton Anxiety Rating Scale [HARS-14] scores). Eight out of fifteen (53%) subjects responded (under 13 points in Edinburgh depression scale [EDS-10] scores). There were no adverse effects in patient or infant during the pregnancy or in the post-natal period. Mild headache was the only common adverse event and was reported by 4 of 15 (26%) subjects. (p<0.05, Wilcoxon)

Conclusions: Maintenance rTMS may be an effective and feasible treatment option for pregnant and postpartum women with major depressive disorder who do not opt to take antidepressant medication.